The Top 50 Articles and Authors of the New Millennium in Psychiatry: A Bibliometric Analysis

The field of psychiatry faces significant challenges in the new millennium, marked by a surge in mental health diagnoses coupled with barriers to accessing adequate care. Despite obstacles, notable advancements have been achieved throughout the field, including the release of DSM-5, the introduction of esketamine, and the development of innovative assessment tools. This study aims to comprehensively analyze recent advances in psychiatry by examining the top 50 most cited articles and authors since 2000, addressing a gap in the literature left by previous subfield-focused bibliometric studies. Utilizing the Web of Science (WOS) database, this bibliometric analysis examined all publications in psychiatric journals from January 1, 2000, to September 18, 2022. The top 50 most cited articles and authors were identified and characterized based on various metrics, including times cited, article type, and institutional affiliations. WOS extracted 699,005 articles, with authors from the United States contributing the highest number of publications. The top 50 articles spanned a variety of formats, with cross-sectional studies, new measures, literature reviews, and randomized controlled trials being the most prevalent. The American Journal of Psychiatry emerged as the leading journal, hosting eight of the top 50 articles. Among the top 50 authors, female representation was limited, comprising 24% of first authors and 22% overall. Institutional affiliations revealed a majority of top authors worked at universities affiliated with the top 40 NIH-funded departments of psychiatry, with those affiliated with Harvard University leading in authorship contributions. This study sheds light on recent advancements in psychiatry, emphasizing the underrepresentation of female authors and the prevalence of top authors affiliated with major NIH-funded programs. This bibliometric analysis provides a comprehensive overview of recent advances and the top recent contributors in the field, fostering a deeper understanding of the evolving landscape of psychiatry in the new millennium.


Introduction And Background
The new millennium has brought substantial challenges to the field of psychiatry.Data suggest that over 20% of American adults now experience mental illness; the years between 2008 and 2019 saw a 30% increase in mental health diagnoses in adults over 18 [1][2][3][4].However, the increased need for mental healthcare is not reflective of the number of patients receiving the care they need to safely and properly manage their mental health; social stigma, insurance coverage, and lack of access to skilled psychiatric clinicians continue to impede the provision of psychiatric care in this country [5,6].The balance between demand and supply of mental healthcare in the United States is a problem yet to be resolved, a problem that requires both scaling of existing best practices and research into new and innovative solutions.
While the challenges to psychiatric care in this country are immense, the new millennium has thus far brought great progress to the field.The release of the DSM-5 in 2013 updated psychiatry's toolbox to treat and diagnose [7].The discovery and approval of esketamine, the first novel method of action antidepressant in 50 years, has revolutionized options for those suffering from treatment-resistant depression [8].The development of the Connor-Davidson Resilience Scale (CD-RISC) was able to provide an insightful predictor for patient improvement in response to treatment [9].Similarly, the assessment and analysis of the CIDI-SF scale, K10/K6 nonspecific distress scales, and the WHO-DAS for the screening of serious mental illnesses have allowed crosstalk between community and clinical epidemiology [10].The new millennium has brought psychiatry into an unprecedented era of ground-breaking research.
With both the volume of new research in the field and the great progress that has been made in the past two decades, a survey of the most impactful recent advances and top researchers is needed to inform those new to psychiatry.Many bibliometric studies have been dedicated to aggregating and analyzing top-cited articles in psychiatric sub-fields.However, these studies do not provide a broad survey of recent advances in the field [11][12][13][14].To our knowledge, there exists only one other notable psychiatry-wide bibliometric analysis: in 2013, Mazhari sought to identify characteristics of the top 100 most cited articles published in international journals dedicated to psychiatry [15].Mazhari's collected articles were published between 1957 and 2005; a study of recent advances in the field and characterization of those innovators making these advances is needed to inform field-wide discussion.

Top articles in psychiatric journals
The 50 highest-cited publications in psychiatric journals since 2000 are listed in Table 1.These publications were cited between 15,001 and 1,964 times."Lifetime prevalence and age-of-onset distributions' of DSM-IV disorders in the national comorbidity survey replication" was the highest-cited publication with 15,001 citations.In this landmark 2005 cross-sectional analysis, Kessler et al. shed light on the prevalences of DSM-IV psychiatric disorders in adults, work that has proven foundational not only to the field of psychiatric epidemiology but to psychiatry as a whole.A commentary letter entitled "Diagnostic and Statistical Manual of Mental Disorders" was reported as the second highest cited publication with 8,592 citations in the WOS database; cross-validation of this article using the article's PubMed ID (21741095) revealed only 24 citations.Upon further inquiry, it became clear this article had erroneously received credit for citations in WOS that should have been attributed to the DSM-V.Finally, "Short screening scales to monitor population prevalences and trends in non-specific psychological distress" was reported as the third highest-cited article with 5,559 citations in WOS.In this article describing new clinical measures, Kessler et al. discuss the implementation and validation of two screening scales for psychological distress, the K6 and K10.

Top authors in psychiatry
The 50 most cited authors in psychiatry are listed in

Discussion of findings
This study used the Web of Science (WOS) database of articles published in psychiatric journals from 01/01/2000-09/18/2022 to identify the 50 most cited publications as well as the 50 most cited authors for a bibliometric analysis.Within the 50 most cited psychiatric journal publications of the new millennium, the analysis found that, first, these publications were cited between 1,964 and 15,001 times.Second, the most popular types of highly cited articles were cross-sectional studies, new measures, literature reviews, and randomized controlled trials.Third, the journal with the most top 50 highest-cited publications was the American Journal of Psychiatry, with eight out of the top 50 publications.
Our authorship analysis revealed, first, that female authors remain underrepresented in recent advances in psychiatry, comprising 12 of the 50 first authors of top psychiatry articles and 10 of the 50 senior authors of top psychiatry articles.Within the 50 top authors, just 11 (22%) were female authors.This percentage is similar to the 23% of psychiatry department chairs who were female in a recent analysis of women in academic psychiatry, despite women accounting for 34% of full professors in the field [85].Second, our analysis showed that 27 (54%) top-50 authors were affiliated with a top 40 NIH-funded psychiatry program in the US, with an additional six (12%) authors affiliated with the NIH itself.Thus, approximately two-thirds of top authors in psychiatry across the world work within the NIH or one of the top 40 US psychiatry departments to which it grants funding.A third of top authors in psychiatry were affiliated with just four US institutions: 36% of top authors were affiliated with the NIH, Harvard University, Duke University, or Columbia University.Third, this analysis shows that MDs and PhDs appear to contribute to top-cited articles in psychiatry relatively equally; from this analysis, it appears that holding an MD or a PhD is nearly universal among top authors in the field, but those with either degree can reach the top levels of impact in the field.
Many bibliometric studies have concentrated on specific subfields of psychiatry rather than the general field; one salient exception was a bibliometric analysis conducted by Mazhari in 2013 [15].There is a paucity of studies that provide a broad survey of the recent psychiatric advances of the past two decades.Mazhari's study focused on the top 100 publications and considered publications between 1957 and 2005 [15].This study includes the characteristics of the most-cited researchers across psychiatry in addition to the top publications, an additional dimension that adds to prior field-wide knowledge of top articles.Our criteria for inclusion as a "top author" presents a more nuanced look at leading authorship compared to measures such as H-index and provides a less ephemeral look at productive contributions to the field than resources such as the Blue Ridge Institute's yearly characterization of top grant-getters in psychiatry [18].Thus, this study attempts to fill the gap in current literature by highlighting recent advances and those at the forefront of psychiatry in a manner that captures recent and lasting literary impact.Furthermore, it examines an uncharacterized recent period in the field, starting in 2000.
This study had several notable limitations.First, when the publications found in the WOS database were cross-verified with PubMed, this revealed that the article "Diagnostic and Statistical Manual of Mental Disorders" was erroneously reported to be cited more than it actually had been in the WOS database.Other limitations of this data source and our search criteria are the limited inclusion of relevant articles in psychiatry published in journals nonspecific to psychiatry, including the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) trial and genome-wide association studies showing relevance for bipolar I disorder [86,87].Other notable exclusions include articles published by NEJM, JAMA, and JAMA Internal Medicine pertaining to opioid-and cannabis-related areas of study of interest to both psychiatrists and general medicine.Finally, this study did not investigate the temporal aspect of the top publications or authors; thus, some publications could potentially be cited more frequently simply due to their earlier date of publication than because of their relative contribution to psychiatry.

Conclusions
This study is one of the few to report top authors and articles in psychiatry for those interested in a broad overview of the field.More specifically, we highlight the characteristics of the most-cited publications and authors in psychiatry, which shows both types of articles and the authors who end up receiving the largest number of citations.Understanding these recent top authors and their highly cited articles can serve as a useful starting point for anyone wishing to obtain a broad education in the recent history of psychiatry, as well as those one day hoping to become top authors in the field themselves.

Table 2 .
(5))top five authors collectively had 445,740 citations and 3,635 publications.Of the 50 most-cited publications, female authors comprised 12 of the 50 (24%) first authors and 10 of the 50 (20%) senior authors.Of the 50 most cited authors in psychiatry, 11 (22%) were female authors.Notably, Ronald Kessler was the author of seven of the 50 publications.Of the 50 most cited authors in psychiatry, 27 (54%) authors were associated with a top 40 NIH-funded psychiatry program in the US.The top three university affiliations of top authors included Harvard University (five authors), Duke University (four authors), and Columbia University (three authors).All but one top author had a PhD/DrPH(23), MD(21), or both of these degrees(5).

TABLE 2 : 50 top authors of the new millennium in psychiatry.
NIH: National Institutes of Health.